Ribavirin plus interferon versus interferon for chronic hepatitis C.

Area of Science:

• Hepatology
• Virology
• Clinical Pharmacology

Background:

• Hepatitis C virus (HCV) infection is a leading cause of liver disease and death.
• Standard treatment involves pegylated interferon and ribavirin, but its clinical impact remains debated.

Purpose of the Study:

• To evaluate the efficacy and safety of combining ribavirin with interferon versus interferon monotherapy for chronic hepatitis C.
• To assess effects on viral clearance, liver-related morbidity, mortality, and adverse events.

Main Methods:

• Systematic review and meta-analysis of 83 randomized controlled trials involving 12,707 patients.
• Inclusion of trials regardless of blinding, language, or publication status.
• Primary outcomes included sustained virological response, liver morbidity, mortality, and adverse events; subgroup analyses were performed.

Main Results:

• Combination therapy significantly improved sustained virological response across all patient subgroups (naive, relapsers, non-responders).
• Combined treatment reduced liver morbidity and all-cause mortality in the overall patient group, though not significantly in subgroups.
• Increased risks of hematological, dermatological, gastrointestinal, infectious, and miscellaneous adverse events were observed, leading to higher discontinuation and dose reduction rates.

Conclusions:

• Ribavirin plus interferon demonstrates superior efficacy in achieving viral clearance compared to interferon monotherapy.
• While combination therapy may reduce liver-related morbidity and mortality, further evidence is required.
• The benefit-risk ratio must be carefully considered due to significant adverse reactions, increased treatment discontinuations, and associated costs.